Botox by the numbers

Sales: $1.98 billion net sales for Allergan in 2013. About 54 percent of that is for therapeutic uses, 46 percent for cosmetic uses.

Treatments: Worldwide, roughly 35 million vials of Botox were distributed and about 29 million treatment sessions performed between 1989 and 2010.

FDA approved uses:

• Frown lines (wrinkles between the eyebrows)

• Crow's feet

• Chronic migraines

• Severe underarm sweating

• Eyelid spasms

• Crossed eyes

• Overactive bladder

• Upper limb spasticity

• Cervical dystonia (sustained contractions or spasms of muscles in the shoulders or neck)

Sources: Allergan, FDA

The prize that’s driving a $48 billion takeover fight for Irvine-based Allergan Inc. started with a microbe that causes botulism, known in the 1800s as “sausage poison.”

Botox has grown into a juggernaut of cosmetic and medical treatments. It may be best known for relaxing wrinkles, but lately it’s been getting a lot of love from those with chronic migraines and overactive bladders.

Botox is not a one-trick pony. In addition to un-furrowing millions of brows, the injectable drug is used to treat myriad medical problems ranging from crossed eyes to sweaty armpits.

It’s “a pipeline within a product,” says Piper Jaffray specialty pharmaceuticals analyst David Amsellem. “There’s so many ways in which it can be used, both cosmetic and therapeutic.”

Botox sales totaled nearly $2 billion last year, making it almost a third of Allergan’s 2013 revenue. It expects sales to grow another 10 percent this year. The drug is the biggest reason for the company’s success and thus its appeal as a takeover target from the likes of Valeant Pharmaceuticals and activist investor Bill Ackman.

“It was originally expected to be a $1 million drug – obviously that’s changed,” says Jefferies research analyst David Steinberg. “It’s unique to have a drug with so many different diseases that it works in. ... I call it the gift that keeps on giving.”

Botox is a form of botulinum toxin, which is produced by the microbe that causes botulism, a paralytic illness. In the early 1800s, a German doctor first posed the idea that botulism could be used therapeutically.

Injections of Botox in small doses work by weakening or paralyzing muscles, or by blocking nerves. The effects can last about three to 12 months, depending on the treatment.

In the 1960s, a San Francisco ophthalmologist injected the toxin into monkeys to see if it would relax the muscles that cause crossed eyes.

Allergan acquired the rights to the ophthalmologist’s product in 1988. A year later, when the drug was approved by the FDA for the treatment of crossed eyes and excessive blinking, it was given the name Botox. The drug won another therapeutic approval from the agency in 2000 for cervical dystonia, a condition that causes spasms, stiffness and pain in the neck.

The first approval for cosmetic use came in 2002, for injecting Botox into “frown lines” between the eyebrows. That’s when Botox was launched into popular culture. And the business possibilities – especially in youth-obsessed Southern California – exploded.

Prior to Botox and fillers, there weren’t many nonsurgical alternatives for softening wrinkles, according to dermatologist Dr. Vince Afsahi. He says he does a fair amount of Botox injections in his Tustin and Newport Beach offices every day.

“Once we started with Botox, injecting it caught on like wildfire because you see the results,” Afsahi says. He attributes Botox’s popularity to the drug standing “the test of time,” being noninvasive, and taking just a few minutes to inject. It also requires minimal downtime for a patient and is relatively easy maintenance. Patients only need to come in three to four times a year for the treatment, Afsahi says.

“You look at anybody in their 50s and 60s – everyone has creases or wrinkles they’d like to soften. So the popularity is built in. … It really sold itself.”

Celebrity endorsements didn’t hurt, either. Academy Award nominee Virginia Madsen has been featured in Botox commercials. Vanessa Williams told Al Roker that she started getting injections while filming the hit show "Ugly Betty".

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